First patient fall...

[Shawn4455]

So I had my first patient fall, not sure if ill get criticism or consoling, but I'm doing this to vent a little... So I have almost hit my first year of being an RN never had a fall until now. I work on a dumping ground type of unit with tons of different sick patients, so basically a med/surg/pulmonary/telemetry. I got a transfer from a higher level of care on my first day of work in a semi private room, the patient was a wreck, RR in high 20's, constant pain medications, O2, ETOH intake, etc. etc. and a normal patient about to be discharged the next day in the next bed.

Well all my focus was on the transfer patient the next day, bed 1 crazy sick, I had to fight with the providers to get to look at them and eventually get antibiotics and specialty providers involved, in my professional opinion, I wanted them transferred back to the higher level of care unit, the floor Doctor ultimately refused. Bed two started to over hear what was going on with bed 1 with the doctors talking to the patient and family and how her prognosis was and what not. Well all day the patient had to get up and use the bathroom due to diuretics and called all day for help to use the bedside commode; from me, the tech and whoever got to the call bell. Well throughout the day the bed alarm somehow didn't get turned on, I remember pushing the buttons, but didn't pay attention if they actually activated because bed 1 was so anxious and sick I kept coming over to them. On top of these 2 patients I have 4 other patients to keep up with as well.

A few more hours later, I took my bed 1 somewhere for a test, ultimately bed 2 decided she wanted to get up to use the bathroom and didn't use the call bell. We heard them fall saying help, we all ran in; the patient was hurt and hit their head, I asked them why they decided not to call vs all the other times they called and they said "I overheard that my neighbor was sicker than me, so I didn't want to bother you". We did everything from CT and X-rays to look for fractures and other injuries. No fractures but they ended up having an injury to their head. I contacted neuro surgery and did neuro checks every 30mins to 1 hour until my shift was over, plus more, I stayed an extra 2 hours to make sure the patient was okay and the orders were put in correctly.

I got an confirmation from my director that the patient was OK and pending discharge. But from what my coworkers said recently, administration is angry about the fall and is threatening a lot of repercussions for the next fall for anyone.

I understand the Bed alarm was not on and I'm not sure why it wasn't on, We help each other on our unit with bathroom and what not, so it could have been me, a tech or even another nurse, but ultimately It was failed to put it on, we do not know who, but I still accept responsibility because I'm the RN, I was in an out of the same room all day I should have been more diligent on looking at the bed alarms. I have always impressed administration and my patients, my name is constantly mentioned by patient on HCAHPS and even providers mention how attentive I am and how I "think above my level" I'm so disappointed in my self for letting something like this happen, I'm hopefully transferring to ICU soon and I feel like I don't deserve it now, my coworkers keep telling me to "stop beating yourself up" but I can't seem to help it. I made work harder for anyone else with the looming "next fall you will be fired" type of deal and I feel like I caused it.

*I tried to keep the patient information private by not using Genders and using Vague descriptions, if it is too confusing, I just put "bed 1" and "bed 2"*

[Guest219794]

Having made my share of mistakes, I can tell you my first reaction is to be defensive, and to look at outside causes. I think this is normal. And legitimate. A human can only do so much. When we get overloaded, something has to give.

There is plenty of finger pointing and blame to be shared for this fall, including the PT. But, in reviewing it, compartmentalizing the issues is helpful.

If management truly wanted to reduce falls, they would change the environment that contributes to the falls.

[neuron]

For crying out loud it's just a d%$# fall, it's not a med error, or table turning event, alert patient have some responsibility in it too.

[osceteacher]

My reaction to this is basically - 'It happens'. I don't particularly know what you needed to do differently, falls alarms are not backed up by much evidence, and are just as likely to increase alarm fatigue as actually reduce falls risks.

Just take it as the first of many, and do as much as you can to make that many as small a number as possible.

[Irish_Mist, BSN, RN]

You know what? Administration can kiss my ass. You were dealing with what sounds like an impossible situation. If administration doesn't want falls, how about they staff appropriately? How about we stop downgrading patients from ICU/PCU when they truly aren't ready? Stand your ground and do not let any of the higher ups point their slimy fingers at you.

Truth is, even with every possible safe guard put in place, falls will happen. We are not magicians nor can we be everywhere at once.

[Jennerizer, ASN, RN]

Shawn - stop beating yourself up. Patients are going to fall. It's a fact of life. The only reason administration cares now is because Medicare won't pay for any costs associated with it. Go back 10 yrs & most hospitals weren't even using bed alarms or even tracking falls. Now, where I work...at one point they wanted the night shift to turn on every single bed alarm regardless of whether the patient was or wasn't a fall risk. Talk about insanity. Only reason that got dropped was because of patients complaining on the surveys regarding hospital satisfaction. Administration is ridiculous with their expectations and the nurse is always made to feel like they are being blamed. If the administrators were so concerned, then they'd have better staffing ratios and also something in place where patients with a higher level of acuity don't end up on a unit they don't belong on just because a doctor says so.

Let the guilt go. Focus on what you want in your future and go for it. Don't let this one episode make you second guess everything.

[mondanaz]

Unfortunately, falls happen!

The best you can do at this point is to take a deep breathe, and take the lessons that you can from it.

Within my first six months as a nurse, I had a fall. Luckily no injury but I was very nervous about it. So you are definitely not alone!

All you can do is remind yourself to double check those alarms. Since the fall happened to me, I do the same now as in double checking the alarms and making sure I have chair alarms, etc.

In addition, try to go directly to supervisors when this occurs. Do not make excuses. Take responsibility like you did in this post and go in and ask to talk about the situation. That way, you are in control of the situation and showing the management team that you want to take responsibility and learn from this and prevent it from happening in the future. Most nurses have had this happen. Even those managers, so they may have advice to offer! And prior to meeting with them, make sure you come into it with an attitude of curiosity and positivity and it will be well received!

Let me know if this helps and how it goes!

[AceOfHearts<3]

For crying out loud it's just a d%$# fall, it's not a med error, or table turning event, alert patient have some responsibility in it too.

That's not the right attitude to take. Yes, falls happen BUT they should NEVER be taken lightly. Falls are the number one trauma! Patients can be seriously hurt from falls- I've seen it. Even just a fall out of a chair can be catastrophic. We had a patient fall on my unit and they ended up under with a head bleed, fractured/cracked ribs, etc.

[RobbiRN, RN]

All true: Our ER currently has a new committee studying how to reduce falls. We are often staffed at 4 to 1 (including our trauma rooms) after our minor care patients have been redirected to the fast track area. Only 4 of our 27 rooms are within direct view of the nurse's station. None of our stretchers have alarms.

Anybody got any ideas on what we can do?

[ArmaniX, MSN, APRN]

Falls happen. My first fall happened 3 years into my career.. in the ICU. The patient also happened to be well over 400lbs. There were no injuries, thankfully. All you can do is look back and learn.

[Kooky Korky, BSN, RN]

Thank you for your post, opens a lot for me, I have talked to my director over the phone, but not in person about it yet, I will soon. And yes my floor or...hospital is pretty toxic with administration, its rough, more seasoned nurses (sorry to go back to the rumor mill) Have experienced this before and they always say "its nothing new, its always been like this"

Either way, thank you. I did own up to the error, I wasn't about to start pointing fingers or making excuses, what done is done.

I think not using pronouns is ridiculous. I think you even said "she" in at least one spot. No, I didn't go back and look but I knew the patients were female.

Do not accept guilt just because you are the RN. Might not have been your fault at all.

Sounds like staffing is lousy and your managers are jerks, using intimidation instead of real leadership.

Sounds like Bed 1 needed an ICU, not a nurse who had 5 other patients.

Falls happen. We do everything we can to prevent them, but sometimes they just aren't preventable by us.

I had a pt whose relative tried to get her up to the toilet, despite my explicitly telling both of them not to get her up without staff. This was not ICU, I had 4 or 5 other patients in rooms other than this one, I could not see this pt at all times, plus I was Charge and had an orientee.

She had seemed sort of agitated to me, I had the Resident check her out, Res said "No new orders, just keep an eye on her". Easier said than done outside of ICU, but I did check her at least q 20 - 30 minutes, a not unreasonable interval on normal PP floor.

VSS, normal LOC, Fundus firm, light lochia, all of that. I figured relative would call me for potty or whatever, as I instructed him to do, but he didn't. Pt. fell, hit her head, taken to ICU, post-partum infection diagnosed. Thank God I had had her seen by doctor just shortly prior to fall.

Story had happy ending all around, I was grateful. Sort of aggravated with relative and Res, but glad I wasn't the one who missed the problem. I felt badly but don't see how I could have prevented this fall.

My big message to OP - do NOT blame yourself. They are expecting you to take care of too many patients, some of whom are very ill. Your boss has handled lots of falls, I expect. Seems like no severe sequelae to this fall, thank God. Forgive yourself, learn from this, soldier on.

God bless you.

[Kooky Korky, BSN, RN]

For crying out loud it's just a d%$# fall, it's not a med error, or table turning event, alert patient have some responsibility in it too.

I agree that alert pts have some responsibility. But lawyers, juries, and families won't.

OP, do not beat yourself up, stop admitting guilt, and be honest about how the very needy pt in Bed 1 and the number of other patients, staffing level, and the fall pt's own statement are all contributing factors. Put all of that in the incident report?

Yes. Pt. stated ______. Direct quote.

State the fact that you were occupied with the roommate, who had just come from ICU and who was agitated or whatever the case was. Other staff (name them) occupied with other 44 pts who were on the ward at the time.

There. you indicted staffing and the darned doc who let Bed 1 come to your ward, and the person who fell. And it's all true.

It's also true that "bed alarm checked", along with bed low, locked, call bell at hand, pt instructed to call for assistance when getting up, verbalizes understanding".

Why assume you goofed up with regard to the alarm? Assume you are a darned decent nurse and, to the best of your knowledge, the alarm was on. Assume you were not at fault, not that you were. This side of Heaven, you will never know.

A boss once told me when I was very new and I was very upset about my lack of knowledge, that she didn't go in for self-flagellation. I learned to study, not lament. So buck up, friend.